The sentinel lymph node for early diagnosis

When it comes breast cancer, the sentinel lymph node is the first to be affected by metastases. It is indeed an important parameter to consider for studying and determining the stage of the disease.

«From the breast, via the lymphatic pathways metastases reach the axillary cavity. This area is, in fact, full of lymph nodes, which are the first to be affected by metastatic cells in case of breast cancer – says Diego Ribuffo, professor of plastic surgery at the University of La Sapienza in Rome and a member of the Breast Unit at Umberto I -. If the sentinel lymph node is negative, which means free of metastases then all the others will be as well».

Depending on the number of lymph nodes involved and the amount of metastasis found in this lymph node, it is possible to get an overall picture of the disease and determine subsequent therapies.

How to identify the sentinel lymph node

The procedure to detect and to analyse the sentinel lymph node is very specific and is performed in Breast Units. It is a procedure that avoids lymph node dissection and thus the removal of all lymph nodes in the axillary region, which often causes lymphedema after a mastectomy.

«To identify the sentinel lymph node, the tissues near the tumor must be marked with a radiopharmaceutical. This is injected into the affected area, and with a probe that detects very low-level radiation, two or three nodes are identified – explains Ribuffo -. To analyse them, a histological examination with special markers is necessary because what we are looking for are not the so-called macro metastases, but rather single cells».

Looking to the future of breast cancer treatment, Professor Ribuffo, who primarily focuses on breast reconstruction, has an encouraging outlook on care and treatment procedures. He talks about prophylactic mastectomy, which is a preventive surgery. This procedure involves removing the entire gland wile preserving the outer envelope, including the skin, dermis, and nipple.

«The scenario for the next 20 years will likely involve fewer procedures by breast surgeons and more interventions by plastic surgeons to treat necrosis caused by chemotherapy or radiotherapy. Axillary dissection is now very rare, and very few patients will undergo these types of surgeries – Ribuffo continues -. Thanks to advances in genetics and genomics, we will be able to identify patients with particular mutations who are thus candidates for customised chemotherapy or radiotherapy».

The role of Breast Units

When it comes to breast cancer prevention, ultrasound and mammography are the main tests performed for early diagnosis.

«Despite screening being free, also proposed by regions through a letter sent home, and despite constantly being positively addressed in the media, only just over half of Italian women in the screening age group undergo the test. In addition to regular exams, self-checks through self-examination and inspection that can be performed daily by the patient herself are essential», explains the professor.

Ribuffo also emphasises the importance of relying on Breast Units to receive personalised and timely treatment. «The benefits are numerous. It has been shown that being treated in these centres increases the chances of survival for patients. Within Breast Units, there is a strong collaboration among specialists in various field dedicated to a single pathology. They study, discuss cases and sinergistically find a shared therapy», Ribuffo concludes.